Correlation Between Serum Aquaporin-4 And The Functional Prognosis Of Patients With Non-cardiac Ischemic Stroke

Purpose By detecting the changes in serum aquaporin-4(AQP4)in patients with non-cardiac ischemic stroke(NCIS),the correlation between serum AQP4 and the functional prognosis of patients with NCIS was explored.Methods We continuously collected ischemic stroke patients who met the inclusion and exclusion criteria in the department of neurology of our hospital from May 2020 to October 2020.After TOAST classification,147 patients with NCIS were collected as stroke group,mainly including 58 cases of large artery atherosclerosis(LAA)and 89 cases of small artery occlusion(SAO).We selected healthy subjects matching the age and sex of the stroke group as the control group.The general clinical data of the control group and the stroke group were collected,including age,gender,body mass index,smoking history,diabetic lesions,hypertensive lesions and history of abnormal blood lipids.The fasting serum indexes of the enrolled patients were collected the morning after admission,mainly including red blood cells,white blood cells,neutrophils,platelets,triglycerides,total cholesterol,low-density lipoprotein/high-density lipoprotein,glycosylated hemoglobin,creatinine,and urea nitrogen,uric acid,PT-INR,etc.We used the Pullicino formula to calculate the infarct volume and NIHSS to evaluate the neurological deficit.We collected 5ml of fasting blood from stroke group and control group,and used ELISA to detect serum AQP4.We compared the differences in general clinical data and serum AQP4 between the stroke group and the control group,and analyzed the differences in serum AQP4 between the stroke subgroups and the control group.We used mRS to assess the functional prognosis of stroke group patients at 90 days.We assessed m Rs>2 points as poor prognosis,and m Rs≤2 points as good prognosis.We divided the stroke patients into two groups based on the median serum AQP4,and analyzed the differences in general clinical data between the high AQP4 group and the low AQP4 group.According to mRS,patients were divided into two groups with poor prognosis and good prognosis for univariate analysis,and the binary logistic regression model was used to analyze and compare the differences in clinical characteristics and functional prognosis between the two groups.We collected general clinical data of the control group and the stroke group.We used the ROC to assess the predictive value.Under the 95% CI,P<0.05 was considered statistically significant.Results1.Comparison of general clinical data between the stroke group and the control group:Compared with the general clinical data of the control group,there are more patients in the stroke group who have a history of smoking,hypertension,and type 2 diabetes.There are statistical difference between the two groups(P<0.05).The levels of glycosylated hemoglobin and low-density lipoprotein/high-density lipoprotein in the stroke group are higher.There are significant statistical difference between the two groups(P<0.001).There are no statistical difference between the two groups in body mass index,triglycerides,and total cholesterol(P>0.05).2.The serum AQP4 of the stroke group is significantly higher than that of the control group,(2.16(1.27)ng/m L)vs(1.52(0.56)ng/m L).There are significant statistical difference between the two groups(P< 0.001).3.The LAA group serum AQP4 is significantly higher than the control group serum AQP4,(2.08(1.37)ng/ml)vs(1.52(0.56)ng/ml).There are significant statistical difference between the two groups(P=0.001).The SAO group serum AQP4 is significantly higher than the control group serum AQP4,(2.21(1.22)ng/ml)vs(1.52(0.56)ng/ml).There are significant statistical difference between the two groups(P<0.001).4.According to the median serum AQP4,the patients are divided into two groups.Compared with the AQP4≤2.16 ng/m L group,the AQP4>2.16 ng/m L group accounts for more patients with poor prognosis,14 cases(18.9%)vs 27 cases(37.0%),there are statistical difference between the two groups(P=0.015).There are no significant difference between the two groups of patients in age,gender,body mass index,smoking history,hypertension,type 2 diabetes,admission to NIHSS,admission time,infarct volume,TOAST subtype proportion(P>0.05).5.Comparison of general clinical data between the poor prognosis group and the good prognosis group: According to the mRS of the enrolled patients with stroke at 90 d,the patients are divided into poor prognosis group(mRS>2 points)and good prognosis group(mRS≤2 points).Compared with the good prognosis group(106 cases,(72.1%)),the poor prognosis group(41 cases,(27.9%))has older patients,more males,higher NIHSS,larger infarct volume,and more LAA proportion,higher neutrophils,higher creatinine,higher uric acid,higher PT-INR,and lower triglyceride levels.There are statistical difference between the two groups(P<0.05).There are no statistical difference between the two groups of patients in body mass index,smoking,hypertension,type 2 diabetes,admission time,red blood cells,white blood cells,platelets,urea nitrogen,glycosylated hemoglobin,total cholesterol,low density lipoprotein/high density lipoprotein(P>0.05).6.The poor prognosis group(41 cases,(27.9%))serum AQP4 was significantly higher than the good prognosis group(106 cases,(72.1%))serum AQP4,(2.68(1.57)ng/m L)vs(1.99(1.17)ng/m L)).There are significant statistical difference between the two groups(P=0.001).7.Multivariate logistic analysis of risk factors for poor prognosis of stroke at 90 days:The results show that serum AQP4(OR=2.571,95%CI 1.418-4.661,P=0.002)and NIHSS(OR=1.230,95%CI 1.041-1.452,P=0.015)are independent risk factors for the poor prognosis of stroke at 90 days.8.The predictive value of serum AQP4 levels in predicting the poor prognosis of different types of stroke at 90 days: The AUC for serum AQP4 in predicting the poor prognosis of NCIS,LAA,SAO at 90 days is 0.67.6(P=0.001,95%CI: 0.579-0.773),0.706(P=0.008,95%CI: 0.571-0.840),0.695(P=0.018,95%CI: 0.560-0.830),respectively.The best prediction point of NCIS,LAA,and SAO is 2.590ng/m L(sensitivity 56.1%,specificity 73.6%),2.270ng/m L(sensitivity 57.7%,specificity78.1%),2.655ng/m L(sensitivity 66.7%,specificity 70.3%),respectively.Conclusion1.High levels of serum AQP4 is associated with poor functional prognosis of patients with NCIS.Serum AQP4 have the potentiality to predict the functional prognosis of patients with NCIS.2.Admission NIHSS is an independent risk factor for the poor functional prognosis of patients with NCIS.